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Purpose: The purpose of this study was to investigate the rate of compliance of air kerma strength (AKS) measurements of iodine-125 (I-125) seeds with international recommendations by departments in Australia and determine the potential impact of noncompliance., Methods and Materials: To achieve this aim, we present an intercomparison of AKS measurements for a single I-125 seed performed by 11 radiotherapy departments in Australia. Measurements were performed at two sites, with each participating department traveling to one of the two host sites and measuring the AKS using their own equipment and local protocols. Each of the AKS measurements was compared with each other and the manufacturer-certified AKS., Results: Nine of the 11 participating departments measured AKS fell within ±3% of the manufacturer's calibration certificate value, whereas all participating departments measured AKS within ±5% of the manufacturer's calibration certificate value. The total spread of the measured AKS among the 11 departments was 7.7%. Only two of the 11 participating departments complied with international recommendations and had their well chamber calibrated within the last 2 years. In addition, 2 of the 11 departments used a well chamber calibrated that was calibrated with a different seed model used during the intercomparison, whereas 4 of the 11 departments calibrated their well chamber "in-house" using a factory-calibrated seed provided by the seed manufacturer., Conclusions: A significant variation in the methods used and frequency of calibration of well chambers were observed among the participating departments. The results of this study support the international recommendations on frequency and methodology of well chamber calibration. Failure to follow these recommendations significantly increases the uncertainty in AKS measurement of I-125 seeds., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to use current American Thyroid Association (ATA) management guidelines to identify groups who might be at risk of overtreatment with radioactive iodine (RAI) ablation after surgery for low-risk papillary thyroid cancer (PTC)., Methods: PTC patients were identified using the Surveillance, Epidemiology and End Results database. Characteristics of low-risk patients (defined as T1 without metastasis) were compared to those not low-risk. Predictors of receiving RAI for low-risk disease were determined using logistic regression., Results: Of 32,229 cases, 17,286 (53.6%) were low-risk. Low-risk patients, compared to others, were older (mean age 51.3 versus 48.5 years), and more often female (81.6% versus 71.7%), white (69.7% versus 62.0%), and insured (87.6% versus 85.6%)(all p-values < 0.001). Nearly 25% of low-risk patients received RAI. Predictors of overtreatment with RAI included age <45 years (OR: 1.393; 95% CI: 1.250-1.552), age 45-64 years (OR: 1.275; 95% CI: 1.152-1.412), male sex (OR: 1.191; 95% CI: 1.086-1.305), Hispanic (OR: 1.236; 95% CI: 1.110-1.376) and Asian (OR: 1.306; 95% CI: 1.159-1.473) race, and extensive lymphadenectomy (OR: 1.243; 95% CI: 1.119-1.381)., Conclusion: Low-risk PTC patients were more likely to receive post-surgical RAI when not indicated under ATA guidelines if they were younger, male, Hispanic or Asian, or underwent extensive lymph node surgery. Identification of groups at risk for overtreatment can help impact practice patterns and improve the effective utilization of healthcare resources., (Copyright © 2019. Published by Elsevier Ltd.)

Aim: This work describes a small-scale production of iodine-124 using a 16.5 MeV cyclotron, and a subsequent validation of the formulated sodium [124I]iodide solution for routinely clinical applications., Methods: Iodine-124 ( 124 I) was produced via the 124 Te(p, n) 124 I reaction using a 16.5 MeV GE PETtrace® cyclotron. Irradiation was performed with a pre-prepared solid target consisting of [ 124 Te]TeO 2 (99.93%) and Al 2 O 3 . Different layer thicknesses, irradiation and extraction parameters were tested. After irradiation at the cyclotron, the shuttle with irradiated material was transferred fully automatically via a tube system to the Comecer ALCEO ® Halogen 2.0 extraction unit. Iodine-124 was subsequently extracted in form of sodium [ 124 I]iodide ([ 124 I]NaI) in 0.05 N aqueous NaOH solution, followed by reconstitution and validation for preclinical and clinical uses., Results: Good result was achieved using a beam degradation foil of 500 µm thickness in combination with beam currents between 10 and 15 µA. Under these conditions, up to 150 MBq no-carrier-added [ 124 I]NaI was obtained after a 2 h irradiation time in less than 500 µl 0.05 N NaOH. Isolation of [ 124 I]NaI, including evaporation and extraction at the ALCEO ® Halogen EVP unit was accomplished in 90 min 24 h after production (irradiation), the amount of iodine-123 as assessed by gamma-ray spectroscopy was less than 1.5%. The undesirable iodine-125 was not detectable by gamma spectroscopy. The extracted [ 124 I]NaI could be used directly for radiolabeling purposes, and after buffering with phosphate buffered saline (PBS) and sterile filtration for clinical applications., Conclusions: Through the optimized conditions for irradiation and extraction, iodine-124 was produced in good radiochemical yields and high radionuclide purity. The generated injectable [ 124 I]NaI solution was sterile, non-pyrogenic and ready for preclinical and clinical applications after a sterile filtration through a 0.22 µm membrane filter., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To provide useful information for the further production and application of this novel radio-nuclide for potential clinical application., Methods: 124 Te (p,n) 124 I nuclide reaction was used for the 124 I production. Firstly, the target material, 124 TeO 2 (200 mg) and Al2O3 (30 mg) mixture, were compressed into the round platinum based solid target by tablet device. HM-20 medical cyclotron was applied to irradiate the solid target slice for 6-10 h with helium and water cooling. Then, the radiated solid target was placed for 12 h (overnight) to decay the radioactive impurity; finally, 124 I was be purified by dry distillation using 1 mL/min nitrogen for about 6 hours and radiochemical separation methods. Micro-PET imaging studies were performed to investigate the metabolism properties and thyroid imaging ability of 124 I.After 740 kBq 124 I was injected intravenously into the tail vein of the normal mice, the animals were imaged with micro-PET and infused with CT. The micro-PET/CT infusion imaging revealed actual state 124 I's metabolism in the mice., Results: It was been successfully applied for 200 mg 124 TeO 2 plating by the tablet device on the surface of platinum. It showed smooth, dense surface and without obviously pits and cracks. The enriched 124 Te target was irradiated for 6 to 10 hours at about 12.0 MeV with 20 μA current on HM-20 cyclotron. Then 370-1 110 MBq 124 I could be produced on the solid target after irradiation and 370-740 MBq high specific activity could be collected afterdry distillation separation and radio-chemical purification. 124 I product was finally dissolved in 0.01 mol/L NaOH for the future distribution. The gamma spectrum of the produced 124 I-solution showed that radionuclide purity was over 80.0%. The micro-PET imaging of 124 I in the normal mice exhibited the thyroid and stomach accumulations and kidney metabolism, the bladder could also be clearly visible, which was in accordance with what was previously reported. To the best of our knowledge, it was the first production of 124 I report in China., Conclusion: In this study, the preparation of 124 TeO 2 solid target was successfully carried out by using the tablet device. After irradiation of the 124 TeO 2 solid target and radio-chemical purification, we successfully produced 370-740 MBq high specific activity 124 I by a cyclotron for biomedical application, and micro-PET imaging of 124 I in normal mice exhibited the thyroid accumulations. Also, slight uptake in stomach were also monitored with almost nonuptake in other organs in the micro-PET imaging. The production of 124 I is expected to provide a new solid target radionuclide for the scientific research and potential clinical application of our country.

Three comparison exercises have been performed in 1996, 1999 and 2015 with 123 I to assess the UK hospitals measurement capabilities using radionuclide calibrators for this particular radionuclide. The exercise performed in 1996 showed that only 62% of the participants could measure the solution to within 10% of the standardised value and only 28% could measure within 5% of the certificated value. The intercomparison exercise performed in 1999 showed no improvement in the measurement capability, with only 66% of the participants measuring to within 10% of the standardised value. The exercise performed in 2015 showed great improvement in the hospitals measurement capability, 94% of participants reported results within 10% of the certificated activity and 85% of the participants reported results within the 5% of the reported activity. The intercomparison exercises are an important way to identify possible measurement problems within the medical community. Additionally, the intercomparison exercises provide hospitals with traceability to national primary standards and improve measurement capability within the Nuclear Medicine community., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Iodine environmental measurements have consistently been validated in the literature using the standard material IAEA-375, soil collected approximately 160 miles northeast of Chernobyl, which is currently the only soil/sediment material with a certified 129 I activity. IAEA-375 has not been available for purchase since approximately 2010. Two other standard materials that are available (NIST SRM 4354, freshwater lake sediment and NIST SRM 4357, ocean sediment) have certified activities for a variety of radionuclides but not for 129 I. This paper reports a comparison of TIMS and AMS data for all three standards., (Copyright © 2017. Published by Elsevier Ltd.)

Differentiated thyroid cancer (DTC) is a rare malignant disease, although its incidence has increased over the last few decades. It derives from follicular thyroid cells. Generally speaking, the prognosis is excellent. If treatment according to the current guidelines is given, cases of recurrence or persistence are rare. DTC requires special expertise by the treating physician. In recent years, new therapeutic options for these patients have become available. For this article we performed a systematic literature review with special focus on the guidelines of the American Thyroid Association, the European Association of Nuclear Medicine, and the German Society of Nuclear Medicine. For DTC, surgery and radioiodine therapy followed by levothyroxine substitution remain the established therapeutic procedures. Even metastasized tumors can be cured this way. However, in rare cases of radioiodine-refractory tumors, additional options are to be discussed. These include strict suppression of thyroid-stimulating hormone (also known as thyrotropin, TSH) and external local radiotherapy. Systemic cytostatic chemotherapy does not play a significant role. Recently, multikinase or tyrosine kinase inhibitors have been approved for the treatment of radioiodine-refractory DTC. Although a benefit for overall survival has not been shown yet, these new drugs can slow down tumor progression. However, they are frequently associated with severe side effects and should be reserved for patients with threatening symptoms only., Competing Interests: The authors declare no conflict of interest.

Background & Objectives: The reference radioactive iodine uptake (RAIU) values established in the 1970s in the era of widespread iodine deficiency were relatively high. Now, after four decades of successful Universal Salt Iodization (USI) programme in India, there is a need to re-establish these reference ranges. The present study was aimed to quantify the two-hour and 24-h RAIU values in iodine sufficient euthyroid individuals and validate the results in Graves' and Hashimoto's thyroiditis patients., Methods: In this prospective study conducted from April 2012 to September 2013, euthyroid volunteers who consented for the investigations were enrolled in the study. Treatment-naive Graves' disease and Hashimoto's thyroiditis patients were recruited from the outpatient clinic. The investigations included neck ultrasonography, thyroid function tests, thyroglobulin (Tg), anti-Tg and anti-thyroid peroxidase antibody and urinary iodine concentration., Results: Three different groups comprising 110 euthyroid volunteers, 38 Graves' and 17 Hashimoto's thyroiditis patients were enrolled in the study. The mean 2-h RAIU values for the euthyroid group, Hashimoto's thyroiditis and Graves' patients were 3.83±2.77, 4.22±3.41 and 32.67±15.93 per cent, and mean 24-h RAIU values were 12.75±5.51, 11.66±9.55 and 61.85±12.9 per cent, respectively. The mean thyroid volumes were 7.63±2.72, 7.81±1.67 and 20.76±12.56 ml for the euthyroid, Hashimoto's thyroiditis and Graves' disease groups and the mean spot urinary iodine concentrations were 9.0, 7.8 and 13.9 μg/dl in the three groups, respectively. The new reference range (95% confidence interval) for two-hour was 1-7 per cent and 24-h was 7-18 per cent., Interpretation & Conclusions: Compared to the previous values, there was a considerable decrease in the RAIU values in euthyroid individuals. This was further corroborated with increase in the urinary iodine concentration and decrease in thyroid volume, attributed to successful USI programme. Further studies with a large sample from different parts of India need to be done to confirm these findings.

The procedure guideline for radioiodine therapy of differentiated thyroid cancer (version 4) was developed in the consensus of a representative expert group. This fulfils the level S1 (first step) within the AWMF classification of Clinical Practice Guidelines (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Germany). This procedure guideline completed the guideline for surgical management of thyroid cancer (level S2) with the aspects from nuclear medicine. Controversies over ablative radioiodine therapy in small papillary thyroid cancers and in minimally invasive follicular cancer without angioinvasion, over empirical standard doses for ablative radioiodine therapy, and over the kind of TSH-stimulation were described and the guideline formulated a corridor of good clinical practice. The text has included the recent results from the National Cancer database and the SEER database (both from the USA), indicating that the ablative radioiodine therapy has improved the survival rate even in low risk patients. Such a statistically significant benefit can be detected only by a national cancer registry with long-term follow-up data.

Using NIST-calibrated solutions of (131)Ba and (131)I in the 5mL NIST ampoule geometry, measurements were made in three NIST-maintained Capintec activity calibrators and the NIST Vinten 671 ionization chamber to evaluate the suitability of using (133)Ba as a calibration surrogate for (131)I. For the Capintec calibrators, the (133)Ba response was a factor of about 300% higher than that of the same amount of (131)I. For the Vinten 671, the Ba-133 response was about 7% higher than that of (131)I. These results demonstrate that (133)Ba is a poor surrogate for (131)I. New calibration factors for these radionuclides in the ampoule geometry for the Vinten 671 and Capintec activity calibrators were also determined., (Published by Elsevier Ltd.)

The paper describes the measurements performed at IFIN-HH regarding the creation of a Romanian (124)I standard, consisting of: absolute standardization of the solution by the application of the 4πβ(PC)-γ coincidence method; Calibration of the CENTRONIC IG12/20A ionization chamber with a standardised solution and comparison with a calculated efficiency; γ-ray spectrometry activity measurement and determination of the impurity levels; Comparison of the results of the three methods., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

(124)I is a radionuclide used in the diagnosis of tumors. The National Health Agency requires identification and activity measurement of impurities. Using gamma spectrometry with an efficiency calibrated high-purity germanium detector, impurities (125)I and (126)I in an (1)(24)I production sample were identified. Activity ratios of (125)I and (126)I to (124)I were approximately 0.5% and 98%, respectively., (Published by Elsevier Ltd.)

Positron Emission Tomography (PET) is being increasingly used as a quantitative technique for detecting disease and monitoring patient progress during treatment. To ensure the validity of the quantitative information derived from the imaging data, it is imperative that all radioactivity measurements that are part of the imaging procedure be traceable to national or international standards. This paper reviews the current status of standards for positron emitting radionuclides (e.g., (18)F, (68)Ge/(68)Ga, and (124)I) and suggests needs for future work., (Published by Elsevier Ltd.)

The national traceability chain for (131)I activity measurements performed in nuclear medicine in Cuba is described. At the highest (primary) level, liquid scintillation counting employing the CIEMAT/NIST method is used; at the secondary level, a secondary standard radionuclide calibrator is utilized that allows for a quick and simple transference of the measurement unit to the tertiary level of end-users' instruments. The equivalence of Cuban standards and the assessment of measurement uncertainties at the end-user level are determined through the results of measurement comparisons., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

A photon-photon coincidence system was constructed for the standardization of (125)I and (109)Cd in PTKMR-BATAN, Indonesia. Two NaI(Tl) detectors of 76 mm diameter × 6mm thickness with 0.5mm aluminum window were used, which were positioned approximately symmetrically to the source holder. The electronic chain was almost the same as for a 4πβ-γ system. The CANBERRA Multiport II multi channel analyzer was used for energy calibration and a Philips type PM3092 oscilloscope for visualization of the pulses. A polyethylene plastic was used as the source substrate for the (125)I and (109)Cd samples. The activity of a (125)I solution was measured by the photon-photon coincidence and the efficiency extrapolation method (Schrader and Walz, 1987), whereas the activity of a (109)Cd solution was determined by a tracer method using (125)I (Schrader, 2006). The result of the (125)I activity showed good agreement with the result of measurements using a calibrated ionization chamber, and the result of (109)Cd also showed good agreement with the measurements result using a LEGe detector., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Successful treatment for permanent implant brachytherapy is based on accurate measurement of dosimetry parameters for the seed sources. Literature describes the application of various types of phantom to determine the AAPM TG-43 dosimetry parameters for permanent implant seeds. Previously we created a new type of phantom used to measure the dosimetry parameters of a high dose-rate (192)Ir source. In this study, we modified the phantom to suit to a common type of (125)I seed source (Sinko BT-125-1). The dose-rate constant, radial dose function and anisotropy function of this source were measured in detail and compared with the published values of other similar in-design (125)I seed sources. The experimental results exhibit fairly small measurement uncertainties and good self-consistency. The modified phantom is demonstrated on the measurement of dosimetry parameters for the Sinko BT-125-1 (125)I seed, however, it could easily be used for similar measurements of other permanent implantation seed sources.

Unlabelled: The accuracy with which (123)I activity is measured by a dose calibrator depends on the composition and geometry of the source. The present study assessed the variability of current commercial dose calibrators in assaying liquid (123)I samples., Methods: A calibration procedure for (123)I measurement was performed on 177 dose calibrators (11 manufacturers) at 138 sites in North America and Europe. Using the standard (123)I push-button or dial setting, activity in a 5-mL (123)I calibration source in a 10-mL U.S. Pharmacopeia type 1 glass vial (actual activity previously determined using a National Institute of Standards and Technology-traceable standard metrology chamber) was measured. A portion of the source was then transferred to a plastic syringe (10-, 5-, and 3-mL sizes at different sites), and the activity in the syringe was measured. Calibration factors (CFs) for converting the dose calibrator readings to the reference activities were then determined for the vial and the syringes. Data were analyzed for all calibrators combined and based on device manufacturers. Measurements using a copper attenuator (sleeve) were made for a subset of 10 dose calibrators at sites that used these devices in clinical practice., Results: Mean CFs for the different measurements were as follows: 10-mL vial, 1.278; 10-mL syringe, 0.811; 5-mL syringe, 0.815; 3-mL syringe, 0.792. Almost half of the dose calibrators had vial CFs between 1.2 and 1.3 and 10-mL syringe CFs between 0.7 and 0.8, whereas less than 16% of the instruments had uncorrected readings within ±10% of the reference activities. Although there was a wide range of CFs for different calibrators using the copper sleeve, for each unit the CFs for the glass vial and the 10-mL plastic syringe were virtually identical., Conclusion: On most commercial dose calibrators, the standard (123)I settings result in significant errors in activity measurements for sources in glass vials and plastic syringes. The difference in ionization chamber detection caused by the container composition (glass vs. plastic) is a much larger source of measurement variation than source volume or geometry.

The activity of an (131)I solution was measured at the Cuban Institute, CENTIS-DMR, as well as at the German National Metrology Institute, PTB, within the scope of a bilateral comparison. In particular, the comparison is aimed at an investigation of the measurement capabilities of CENTIS-DMR which provides activity standards in Cuba and organizes national comparisons, placing a particular emphasis on radionuclides for nuclear medicine, such as (131)I. Both institutes applied liquid scintillation counting techniques with efficiency tracing as well as secondary standardization procedures by means of calibrated ionization chambers and gamma-ray spectrometers. The results were checked for consistency and a good agreement was found. Moreover, a virtual link of the Cuban result to the International Reference System (SIR) at the Bureau International des Poids et Mesures (BIPM) is discussed.

To confirm the previous reports demonstrating the difference in the octanol extraction fractions between the currently available two N-isopropyl-4-iodoamphetamine (123I) products (IMP(A) and IMP(B)), we newly developed the standard input function for IMP(B) in 19 healthy volunteers and compared it with the established standard input function, which has been originally generated with IMP(A). The octanol extraction fractions of IMP(B) were stable from 5 minutes to 16 minutes post injection and significantly higher than those of IMP(A). The mCBFs calculated with IMP(B) by using the established standard input function for IMP(A) tended to be higher than those with the combination of IMP(A) and the established standard input function though the difference was not significant. When measured with IMP(B) combined with the correspondent standard input function, mCBFs were identical to those calculated with IMP(A) with the established standard input function, suggesting that the appropriate standard input function should be used according to the product used.

Version 3 of the procedure guideline for (131)I whole-body scintigraphy (WBS) is the counterpart to the procedure guideline for radioiodine therapy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. (131)I WBS 3-6 months after (131)I ablation remains a standard procedure in an endemic area for thyroid nodules and the high frequency of subtotal surgical procedures. Follow-up without (131)I WBS is only justified if the following preconditions are fulfilled: low-risk group pT1-2, pN0 M0 with histopathologically confirmed pN0, (131)I uptake <2%, (131)I WBS during ablation without any suspicious lesion, stimulated thyroglobulin (Tg)-level 3-6 months after ablation <2 ng/mL, and absence of anti-thyroglobulin-antibodies with normal recovery-testing. If patients from the low-risk group show normal (131)I WBS 3-6 months after ablation and stimulated Tg is of <2 ng/mL, there will be no need for additional routine (131)I WBS. If patients from the high-risk group show normal (131)I WBS and stimulated Tg-level of <2 ng/mL 3-6 months after ablation, the follow-up care should include repeated stimulated Tg-measurements. If the Tg-level remains below 2 ng/mL, an additional (131)I WBS will be not necessary. The recommended intervals for stimulated Tg-testing are adapted to the prior intervals for (131)I WBS-testing in the high-risk group. Increased anti-thyroglobulin-antibodies or incomplete recovery-testing make an individual strategy of follow-up care necessary, which include (131)I WBS.

The procedure guideline for radioiodine ((131)I) therapy and (131)I whole-body scintigraphy of differentiated thyroid cancer in paediatric patients is the counterpart to the procedure guidelines (version 3) for adult patients and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Characteristics of thyroid cancer in children are the higher aggressiveness of papillary thyroid cancer, the higher frequency of extrathyroidal extension and of disseminated pulmonary metastases as well as the high risk of local recurrences. Radioiodine therapy is generally recommended in children, the (131)I activity depends on the children's body weight. Radioiodine ablation in children with small papillary cancer (< or =1 cm) should be considered. TSH stimulation is reached two weeks (children) or three weeks (adolescents) after withdrawal of thyroid hormones. Anti-emetic drugs are highly recommended. CT of the chest and examination of pulmonary function are clearly indicated if there is any suspicion on metastases. 3-6 months after (131)I ablation, the (131)I whole-body scintigraphy is highly recommended as lymph node metastases are frequently detected in paediatric patients. Follow-up care should be arranged in shorter intervals than in adults to test the compliance and to adapt dosage of thyroid hormones to the children's body weight. Reference values of fT3 are higher in children than in adults. Evidence is insufficient to describe in which constellation the TSH may be kept within the low normal level. Therefore, TSH suppression is generally recommended.

The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for (131)I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative (131)I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC < or =1 cm (131)I ablation may be helpful in an individual constellation. Preparation for (131)I ablation requires low iodine diet for two weeks and TSH-stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lower blood activity) and the advantages of endogenous TSH-stimulation (necessary for (131)I-therapy in patients with metastases, higher sensitivity of (131)I whole-body scan) are discussed. In most centers standard activities are used for (131)I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of (131)I should not exceed 1-10 MBq, alternative tracers are (123)I or (124)I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene.

Dosimetric characteristics of brachytherapy sources are normally determined in water using a Monte Carlo simulation technique and in water equivalent phantom material using both experimental and Monte Carlo simulation techniques. The consensuses of these results are then calculated for clinical applications by converting experimental data obtained in water equivalent material to water using a conversion factor. These conversion factors are normally determined as a ratio of the Monte Carlo-simulated dose rate constant in liquid water to the dose rate constant in a water-equivalent phantom material. However, it has been noted that conversion factors utilized by some investigators have been derived using incorrect phantom material composition and incorrect cross-sectional data information. The impact of errors associated with the cross-sectional data and chemical composition of the phantom material used in dosimetric evaluation of brachytherapy sources has been investigated in this project. Results of these investigations have shown that the use of Solid Water with 1.7% calcium content, as compared to the 2.3% value stated by the manufacturer, may lead to 5% and 9% differences in conversion factors for 125I and 103Pd, respectively.

Purpose: OncoSeed is delivered in a sterile environment in the form of a cartridge, so it is impractical to resterilize and reload seeds after calibration. We investigated a new method using an imaging plate dosimetry system to characterize all seeds in the OncoSeed cartridge in a sterile environment., Methods and Materials: Seeds within the cartridge were placed on an imaging plate, and the imaging plate irradiated. To remove scatter radiation, and improve spatial resolution of seed images, we used X-ray parallel cross grids. The irradiated imaging plate was scanned using a Bio-imaging Analyzer System, and radioactivity intensities of seed images were given in counts. Counts could be translated to profiles, and each seed within the cartridge was analyzed., Results: Results showed a good correlation between counts and total radioactivity of the seeds within the cartridge. Thus, using a least-squares line, it was possible to characterize a cartridge with unknown apparent activity. By analyzing the profiles, it was possible not only to detect a miscalibrated seed in the cartridge from its relative difference in counts, but also to identify its position in the cartridge. No significant changes in counts were seen between sterile and nonsterile environments., Conclusion: Using an imaging plate dosimetry system, all seeds in a cartridge could be characterized in a sterile environment.

The absolute 4pi-betagamma coincidence counting has been used to measure the activity concentrations of 54Mn and 203Hg, and the Sum-Peak method was used for 125I. 54Mn and 125I radionuclides have been part of international key-comparisons coordinated by the Bureau International des Poids et Measures (BIPM) in 2003/2004, while 203Hg is part of the traceability programme of the National Laboratory for Ionizing Radiation Metrology (LNMRI)/Brazil. Three different detectors were used for the Sum-Peak method: 3''x3'' NaI(Tl) and 5''x5'' well NaI(Tl) scintillation detectors and a planar germanium detector. Direct measurements were made of the photon emission probabilities of the 35.5-, 834.8- and 279.2-keV gamma-rays of 125I, 54Mn and 203Hg to give values of (0.0667+/-0.0014), (0.9997+/-0.0055) and (0.8161+/-0.0005), respectively. The half-lives of 203Hg and 54Mn were also determined by means of a 4pigamma ionization chamber (203Hg) and by the reference source method using a HPGe detector (54Mn) to give values of (46.639+/-0.023) days and (312.1+/-0.9) days, respectively.

Radioactive seeds preloaded in sterilized cartridges or needles are commonly obtainable from manufacturers. Under the US regulations for control of radioactive materials, seed users are required to account for all seeds and independently verify their air kerma strength (SK). As a result, the viability of inspection schemes that rely on measurement of aggregate seeds is of interest. In this paper we consider the conditions (if any) under which cartridge inspection can satisfy regulatory requirements and still provide practical benefit (i.e., time savings) against the regular single-seed assay. The standards for comparison are the recommendations of AAPM TG40, AAPM TG56, and ACR's "Standard for the Performance of Manually Loaded Brachytherapy Sources." The practical benefit is judged in comparison to the effort required to apply the 10% assay recommendation of TG40 to seeds in cartridges. Two specific cartridge inspection schemes are considered: (a) measuring the SK of each cartridge in a batch; (b) measuring a single cartridge sampled at random from the batch. Unlike the 10% assay, which is defined (imperfectly, in our view) without reference to the prevalence of in-calibration seeds, the estimation of the relative merits of cartridge inspection methods must necessarily include such information and, as such, is manufacturer specific. In this paper results are provided for Oncura model 6711 125I seeds in shielded and unshielded Mick cartridges. We show that the only practically useful cartridge inspection scheme is the batch scheme applied to unshielded cartridges. The false positive rates associated with the other schemes are such that we expect to open a cartridge (and perform the 10% assay) at least 80% of the time. While anything less than 100% of the time is theoretically an improvement, this neglects the additional effort required to assay the cartridges.

Rationale and Objectives: To describe radiation safety procedures for limiting exposures during localizing placement of iodine-125 (I-125) seeds in nonpalpable breast lesions. Radiation safety tasks included seed receipt, assay, sterilization, transfer, and placement; surgical localization and retrieval; and extraction of seeds by pathologists. Additional regulatory aspects included institutional review board approval, physician credentialing, off-label use, and governmental licensing., Materials and Methods: Titanium seeds were assayed to ensure strength (1.85-5.55 MBq). Radiologists credentialed in mammography placed seeds with an 18-gauge needle under ultrasound or mammographic guidance. Surgeons located seeds with a hand-held, solid-state radiation detector. I-125 seeds were extracted from excised tissue and secured by pathologists., Results: After the investigational phase, state permission was obtained for the institution's Radiation Safety Committee to oversee the clinical application of the procedure. In more than 300 procedures, all seeds and targeted lesions were removed successfully; more than 98% of patients had seeds removed within 24 hours. Mean diameter of excised specimens was about 4 cm, for a maximum dose to residual breast tissue of 2 cGy (approximately that of a two-view mammogram). Badge monitoring showed no loss of seeds and no increase in physician or technologist exposure. Radiation safety precautions facilitated safe handling., Conclusion: Clinically, the procedure has been accepted as routine, with standardized steps for safe and secure handling of radioactive seeds. Compared with conventional methods, use of I-125 seeds offers an improved method for localizing before surgical excision and has essentially replaced wire localization in our tertiary-care academic medical center.

Calibration of a High-Dose-Rate 1000 Plus ionisation chamber and associated electrometer for the determination of reference air kerma rate for 125I brachytherapy seeds has been developed. Traceability was established from ionisation chamber measurements of an Amersham model 6711 125I seed for which a primary standard measurement of reference air kerma rate has been made by the National Institute of Standards and Technology. The status of an Australian secondary standard is to be realised by establishing legal verifying authority from the National Measurement Institute. The calibrated chamber thus provides a measurement from which similar chambers in hospitals may be calibrated. For quality assurance this result was compared with the calibration certificate supplied by the Accredited Dosimetry Calibration Laboratory of the University of Wisconsin, USA.

In March 2004, the recommendations of the American Association of Physicists in Medicine (AAPM) on the interstitial brachytherapy dosimetry using 125I and 103Pd were reported in Medical Physics [TG-43 Update: Rivard et al., 31, 633-674 (2004)]. These recommendations include some minor changes in the dose-calculation formalism and a major update of the dosimetry parameters for eight widely used interstitial brachytherapy sources. A full implementation of these recommendations could result in unintended changes in delivered dose without corresponding revisions in the prescribed dose. Because most published clinical experience with permanent brachytherapy is based upon two widely used source models, the 125I Model 6711 and 103Pd Model 200 sources, in this report we present an analysis of the dosimetric impact of the 2004 TG-43 dosimetry parameters on the history of dose delivery for these two source models. Our analysis indicates that the currently recommended prescribed dose of 125 Gy for Model 200 103Pd implants planned using previously recommended dosimetry parameters [AAPM 103Pd dose prescription: Williamson et al., Med. Phys. 27, 634-642 (2000)] results in a delivered dose of 120 Gy according to dose calculations based on the 2004 TG-43 update. Further, delivered doses prior to October 1997 varied from 113 to 119 Gy for a prescribed dose of 115 Gy compared to 124 Gy estimated by the AAPM 2000 report. For 125I implants using Model 6711 seeds, there are no significant changes (less than 2%). Practicing physicians should take these results into account when selecting the clinically appropriate prescribed dose for 103Pd interstitial implant patients following implementation of the 2004 TG-43 update dose-calculation recommendations. The AAPM recommends that the radiation oncology community review this report and consider whether the currently recommended dose level (125 Gy) needs to be revised.

Aim: For the examination of the impact on clinical practice of the guidelines for differentiated thyroid carcinoma (DTC), treatment data from the ongoing Multicenter Study Differentiated Thyroid Carcinoma (MSDS) were analyzed., Patients, Methods: Patients were randomized to adjuvant external beam radiotherapy (RTx) or no RTx in addition to standard therapy in TNM stages pT4 pN0/1/x M0/x (UICC, 5th ed. 1997). All patients were to receive the same treatment regimen consisting of thyroidectomy, ablative radioiodine therapy (RIT), and a diagnostic 131I whole-body scintigraphy (WBS) 3-4 months after RIT., Results: Of 339 eligible patients enrolled between January 2000 and March 2004, 273 could be analyzed. Guideline recommendations by the German Society for Nuclear Medicine from 1999 and 1992 were complied with within 28% and 82% with regard to the interval between surgery and RIT (4 vs. 4-6 weeks), in 33% and 84% with regard to 131I activity for RIT (1-3 vs. 1-4 GBq; +/- 10%), and in 16% and 60% with regard to 131I activity for WBS (100-300 vs. 100-400 MBq; +/- 10%)., Conclusions: The 1999 guideline revision appears to have had little impact on clinical practice. Further follow-up will reveal if guideline compliance had an effect on outcomes.

Iodine-131 patients pose a radiation risk to their family members, carers and colleagues. Doses from thyrotoxicosis and thyroid cancer patients undergoing standard treatments have been well characterised in the literature. However the resulting precautions cannot be easily adapted to circumstances where the patient has an unusual affliction, or an atypical family or occupational environment. In this study, a model for calculating dose from an I-131 patient is derived from first principles. The model is combined with existing results from the literature to determine a distance weighting factor between patients and family members. This technique reduces the uncertainty in the dose calculations by removing the need to guess the unknown patterns of close contact, a problem common to all previous dose calculation techniques. Data is presented for four unusual I-131 treatments; a child thyroid cancer patient, two thyroid cancer dialysis patients and a phaeochromocytoma patient. The model is used to calculate appropriate periods of restricted contact for these patients. The recommendations provide a useful guide for future unusual I-131 treatments.

A new method using the Monte Carlo code PENELOPE for ionization chamber simulation has already been successfully used for calculating calibration factors needed for the measurements of radionuclides with photon emission (2003, Appl. Radiat. Isot., to be published). This work has been continued at (Laboratoire National Henri Becquerel) in order to calculate the calibration factors for radionuclides with short half-lives used in medical services. Activity measurements of 18F, 99mTc,111In and 123I using the calculated calibration factors were obtained with standard uncertainties equal to 0.6% for 18F, 99mTc and 1.5% for 111In and 123I.

A simple distance-variable detection table on which two detectors can be mounted and moved back and forth facing each other centred on a sample source has been constructed for photon-photon and alpha-photon coincidence counting for 125I and 238Pu, respectively. Two NaI(Tl) detectors were used for the standardization of 125I. A Si detector and an NaI(Tl) detector were employed for the standardization of 238Pu. The NaI(Tl) detectors have a very thin aluminium window for measuring low-energy photons from 125I and 238Pu while the Si-detector is a usable-in-air ion-implanted detector for alpha particles from 238Pu. A thin collodion film was used for 238Pu samples, whereas a thick polyester film was used for 125I samples to prevent 125I from leaking from the sample. The key comparison result of 125I showed good agreement, and the result of 238Pu was also compared with that of liquid scintillation counting.

Purpose: Three types of radiation sources are employed currently in the radiation treatment of prostate cancer, namely, external, implant, and high-dose-rate (HDR) sources using an afterloader method. The present article provides a detailed dosimetric characterization of several commercially available implant sources and an HDR source employing the same stochastic code and dataset., Methods and Materials: The radioactive implants considered are (125)I seeds: models 6701, 6702 and 6711, (103)Pd seed: model 200, and a high-dose-rate (192)Ir source: microSelectron-HDR model V7.0x. Detailed modeling of the sources and their associated X-rays and gamma rays has been carried out using the stochastic code MCNP4C. A sensitivity study has been conducted to quantify effects of varying the composition and density of the tissue equivalent material, and a dosimetric comparison is made for different media (tissue equivalent, solid-water, water, and air). Furthermore, a set of measurements using thermoluminescent dosimeters has been done to provide experimental validation of some of the calculational results obtained., Results: Effectively, high-precision dosimetric values (Monte-Carlo statistical 1-sigma error <1%) are provided in tabulated form over a wide range to enable therapy planning as well as to check numerical values calculated by other methods. A subset of calculated dosimetric values has been experimentally validated by using thermoluminescent dosimeters., Conclusions: A detailed comparison of results obtained for the radial dose distribution function, anisotropy factor, and dose rate constant as defined in the TG-43 protocol has indicated reasonable agreement with the values reported in the literature.

Values of dose rate constant (DRC) in compliance with AAPM TG 60 formalism recommended for intravascular brachytherapy (IVBT) were calculated for different point isotropic mono-energetic photon sources in the energy range E = 20-1000 keV using a semi-analytic model. Based on these DRC values, DRC of some existing models of 192Ir and 125I brachytherapy sources were then calculated using (1) bare energy spectra and (2) a single energy parameter which represents mean energy (photon number weighted or air-kerma weighted) for bare and actual sources or the most probable energy of the spectra (energy line with the highest probability of emission) of the investigated sources (192Ir and 125I). Applicability of the semi-analytic approach was examined by also computing the values of DRC of the investigated sources using MCNP Monte Carlo simulation code (Version 3.1) that involved modeling of the sources accurately. A comparison of values of DRC resulting from MCNP calculations with those resulting from the semi-analytic approach showed that for 192Ir sources the agreement was within 0.40% and for 125I sources it was within 2.3%.

National intercomparisons of activity measurements of 131I, a radioisotope widely used for diagnosis and therapy of thyroid related ailments, were initiated in 1979 as a quality assurance program, towards improving radiation safety procedures and related dosimetry in Nuclear Medicine Centres (NMCs) in India. Oral administration of a known quantity of radioiodine to patients requires accurate radioactivity measurements to be performed on a well-calibrated isotope calibrators. Under or over estimation of the activity due to a faulty or uncalibrated isotope calibrator could provide misleading results. Calibration of isotope calibrators and the traceablity of subsequent measurements to the national standards laboratory is one of the essential basic radiation safety requirement of the IAEA. In view of the stringent quality assurance requirements for activity measurements imposed by Atomic Energy Regulatory Board, a National Intercomparison Program was initiated and to date ten such intercomparison programs have been conducted by the Radiation Safety Systems Division, of the Bhabha Atomic Research Centre. This program has benefited the participants by making their measurements traceable to the National Primary Standards. Over the years there has been a marked increase in the number of NMCs participating in the intercomparison programs. As a result, the number of institution showing large deviation from the correct value has decreased considerably over the years. This program thus, has enabled participating NMCs to check their isotope calibrators so as to ensure proper delivery of radiation dose to the patients and hence to optimise patient exposure.

The SeedLink brachytherapy system is comprised from an assembly of I-Plant 3500 interstitial brachytherapy seeds and bioresorbable spacers joined together by a 6-mm-long titanium sleeve centered over each seed. This device is designed to maintain specified spacing between seeds during treatment thereby decreasing implant preparation time and reducing radionuclide migration within the prostate and periprostatic region. Reliable clinical treatment and planning applications necessitate accurate dosimetric data for source evaluation, therefore the authors report the results of a Monte Carlo study designed to calculate the AAPM Task Group Report No. 43 dosimetric parameters for the SeedLink brachytherapy source and compare these values against previously published Monte Carlo study results of the I-Plant 3500 brachytherapy seed. For this investigation, a total of 1 x 10(9) source photon histories were processed for each set of in-water and in-air calculations using the MCNP4C2 Monte Carlo radiation transport code (RSICC). Statistically, the radial dose function, g(r), and the dose-rate constant, lambda, were identical to the values calculated previously for the Model 3500 with the dose-rate constant evaluated to be lambda = 1.000+/-0.026 cGyh(-1) U(-1). The titanium sleeve used in SeedLink to bind together Model 3500 seeds and spacers resulted in slightly greater dosimetric anisotropy as exhibited in the anisotropy function, F(r, theta), the anisotropy factor, phi(an) (r), and the anisotropy constant, phi(an), which was calculated to be phi(an) = 0.91 +/- 0.01, or roughly 2% lower than the value calculated previously for the Model 3500. These results indicate that the radiological characteristics of the SeedLink dosimetry system are comparable to those obtained for previously characterized single seeds such as the Implant Sciences Model 3500 I-Plant seed.

The version 2 of the procedure guideline for iodine-131 whole-body scintigraphy for differentiated thyroid cancer is an update of the procedure guideline published in 1999. The following statements are added or modified: The two alternatives of an endogenous TSH-stimulation by the withdrawal of the thyroidal hormone medication and of an exogenous TSH-stimulation by the injection of the recombinant human TSH (rhTSH) have an equal sensitivity for the diagnostic use of radioiodine and for the measurement of thyroglobulin. Image acquisition under rhTSH is obtained approximately 48 h after the radioiodine administration, while an interval of about 72 h is preferred under endogenous TSH-stimulation. If iodine-negative metastases are expected, the feasibility of scintigraphy using (99m)Tc sestamibi or preferably positron emission tomography using (18)F-fluorodeoxyglucose should be considered. The sensitivity of FDG-PET is increased by TSH-stimulation. Before planning the iodine-131 scintigraphy the patient has to avoid iodine-containing medication and the possibility of additives of iodine in vitamin- and electrolyte-supplementation has to be considered.

The version 2 of the procedure guideline for radioiodine test is an update of the guideline published in 1999. The following statements were added or modified: The procedure guideline discusses the pros and cons of a single measurement or of repeated measurements of the iodine-131 uptake and their optimal timing. Different formulas are described when one, two or three values of the radioiodine kinetic are available. The probe with a sodium iodide crystal, alternative or additionally the gamma-camera using the ROI-technique are instrumentations for the measurement of iodine-131 uptake. A possible source of error is an inappropriate measurement (sonography) of the target volume. The patients' preparation includes the withdrawal of antithyroid drugs 2-3 days before radioiodine administration. The patient has to avoid iodine-containing medication and the possibility of additives of iodide in vitamin- or electrolyte-supplementation has to be considered.

The version 2 of the procedure guideline for thyroid scintigraphy is an update of the procedure guideline published in 1999. The procedure guideline considers the current amendment of legislative rules (Richtlinie Strahlenschutz in der Medizin 2002). Indication and use of radiopharmaceuticals have to be confirmed by the specialist in nuclear medicine. Activities of 75 MBq technetium-99m, respectively of 10 MBq iodine-123 should not be exceeded without an individual justification. The interpretation of the scintigraphy requires the knowledge of the patients' history, the palpation of the neck, the laboratory parameters, and of the sonography. The interpretation of the technetium-99m uptake requires the knowledge of TSH concentration.

The calibration of a liquid I-125 source in an older standard dose calibration system is presented. The calibration factor agrees well with factors established by the NIST for newer dose calibration systems. The determination of the source activity is necessary to accurately calculate the time required to deliver the prescribed dose.

Unlabelled: Use of a standard arterial input function and calibrating it by a single blood sample or a continuous arterial blood sample has been researched for a repeat CBF assessment with split-dose administration of N-isopropyl-p[123I]iodoamphetamine (IMP)., Methods: The study population consisted of 5 normal volunteers and 5 patients with cerebrovascular disease. IMP was injected twice (111 MBq/2 ml each) into the anti-cubital vein at a constant infusion speed for 1 min. The arterial input function was monitored during the study including a continuous measurement of radioactivity concentration of both the whole-blood and the octanol-soluble component (Real-Input Function, RIF). Standard input function was determined, and was calibrated either by a single blood sample or a continuous blood sample to estimate the Estimated-Input Function (EIF). Area-Under-the Curve (AUC) was then compared between RIF and EIF., Results: In case EIF was estimated with a single blood sample, the minimum error of estimated AUC was obtained when calibrated at 7 minutes after either the 1st or 2nd injections. Deviation of AUC for [0, 30] was +/- 6.6%, and +/- 5.0%, respectively. If calibrated with a continuous blood sample, the minimum error of AUC with the continuous blood sampling period of 10 min for [0, 30] and [30, 60] was +/- 5.3% and +/- 4.0%, respectively., Conclusions: AUC of EIF with either a single or continuous blood sampling appeared to have reasonably small errors, suggesting the validity of the use of standardized input function in the split-dose IMP SPECT.

The measurement of the activity of a radiopharmaceutical administration to a patient is normally achieved via the use of a radionuclide calibrator. Although these radionuclides are normally measured initially in a standard glass vial, an aliquot of the solution is then usually withdrawn into a syringe prior to the administration. Both for general quality assurance good practice and for additional guarantees for patient safety, a confirmatory measurement of the syringe is almost obligatory Because of the different geometries and elemental compositions between plastic syringes and glass vials, the calibration factors for syringes may well be significantly different from those for the glass containers. The magnitude of these differences depends on the energies of the emitted photons. A variety of syringes typically used in hospital administrations, and covering a range of volumes and manufacturers, were obtained. The results obtained were compared to those for glass vials and show the large errors that can be produced by ignoring these differences in container format.

In the therapeutic use of radionuclides, by far the most rapid growth in recent years is that of 125I seeds used for the treatment of prostate cancer. Large numbers of these seeds are used in each treatment and there is a need for a simple but accurate means of confirming their dose rates. This mechanism requires a transfer device for which the calibration factors are traceable to national standards. The NPL secondary standard radionuclide calibrator, because of its guaranteed reproducibility and traceable calibration procedure, is ideally suited for this purpose. A series of characterisation measurements have been performed on the NPL radionuclide calibrator in order to estimate the uncertainty levels that can be achieved and these are presented together with the relevant calibration factors for some typical seeds.

In order to obtain information on the accuracy of activity measurements in Brazilian hospitals, several intercomparison exercises have been organized since 1998. The first exercise consisted of two intercomparison runs of 131I and 99mTc and had the participation of 21 hospitals localized in Rio de Janeiro city and surroundings. The second, with 131I (47 hospitals) and 123I (12 hospitals), had the participation of hospitals localized in the whole country. The results were analyzed under the statistical point of view and conformity to the norms of Regulatory Authority. These results have shown that such exercises are necessary to improve the quality of the measurements and to identify those instruments that are producing incorrect values.

Flynn, A. A., Green, A. J., Pedley, R. B., Boxer, G. M., Boden, R. and Begent, R. H. J. A Mouse Model for Calculating the Absorbed Beta-Particle Dose from (131)I- and (90)Y-Labeled Immunoconjugates, Including a Method for Dealing with Heterogeneity in Kidney and Tumor. Radiat. Res. 156, 28-35 (2001). Conventional internal radiation dosimetry methods assume that the beta-particle energy is absorbed uniformly and completely in the source organ and that the radioactivity is distributed uniformly in the source. However, in mice, a considerable proportion of the beta-particle energy can escape the source organ, resulting in large cross-organ doses. Furthermore, the distribution of radioactivity is generally heterogeneous in kidney and tumor. Therefore, a model was developed to account for cross-organ doses and for the effects of heterogeneity in kidney and tumor in mice for two of the most important radionuclides used in therapy, (131)I and (90)Y. Most mouse organs were modeled as single-compartment ellipsoids or cylinders, while heterogeneity in kidney and in tumor was addressed by using two compartments to represent the cortex and the medulla and viable and necrotic cells, respectively. The dimensions of these models were taken from previous studies, with the exception of kidney and tumor, which were defined using radioluminography and mosaics of high-power microscopy images. The absorbed fractions in each compartment were calculated using beta-particle point dose kernels. The self-organ dose was significantly higher for (131)I compared to (90)Y in all compartments, but a considerable amount of beta-particle energy was shown to escape the source organ for both radionuclides, with as much as 85% and 36% escaping the marrow for (90)Y and (131)I, respectively. The cortex was found to occupy a greater proportion of the total kidney volume than the medulla, and consequently the self-dose was higher in the cortex. In addition, the thickness of the viable shell in the tumor increased with tumor size, as did the self-dose fractions in both necrotic and viable areas. This dosimetry model improves dose estimates in mice and gives a conceptual basis for considering dosimetry in humans.